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Manor U, Apterman S, Ben-Haim G, Prat D. Physical Trauma Following Rocket Warning Sirens in Israel. Mil Med 2023; 188:e2896-e2899. [PMID: 36383071 DOI: 10.1093/milmed/usac343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/23/2022] [Accepted: 10/19/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Civilians constitute a significant wartime target, and trauma accounts for most of their injuries. Air raid sirens have long been used to alert civilians of incoming attacks and have since expanded to warn from natural disasters. Sirens are known to cause significant emotional distress and physiological changes. Injuries inflicted from trauma while moving for shelter have yet to be described in the medical literature. METHODS During the recent Israel-Gaza conflict of May 2021, most of Israel's population experienced rocket warning sirens. We collected all adult (18<) patients arriving at a major tertiary medical center emergency department (ED), attesting to having suffered their injury while rushing for shelter. Clinical and demographic data were retrieved and analyzed. RESULTS A total of 48 patients were identified, with a mean age of 59.6 ± 20.0. Ten (21%) patients were admitted, and their mean length of stay was 4.4 ± 3.7 days. Women had a higher probability of being hospitalized (42.9% vs. 5.9%, P = .04), and those hospitalized tended to be older (68.8 ± 16.4 vs. 54.8 ± 20.8, P = .06). Elderly patients (65<) had a higher risk of injury. Extremity injuries were most common (50%), before head trauma (29%) and torso injuries (25%). Most patients (38/48, 79.2%) were discharged from the ED, and the rest were hospitalized for observation or surgery. One patient died from a head injury. CONCLUSIONS This study implies that injuries while moving for shelter were a prevalent cause of physical injury to Israeli civilians during the Israel-Gaza 2021 conflict. Warning sirens injuries should be given appropriate attention-from prevention by directed media campaigns to post-conflict reimbursement.
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Affiliation(s)
- Uri Manor
- Internal Medicine "C" Department, Sheba Medical Center, Tel HaShomer 5262000, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sagy Apterman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Orthopaedic Surgery, Sheba Medical Center, Tel HaShomer 5262000, Israel
| | - Gal Ben-Haim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Emergency Medicine, Sheba Medical Center, Tel HaShomer 5262000, Israel
| | - Dan Prat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Orthopaedic Surgery, Sheba Medical Center, Tel HaShomer 5262000, Israel
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Yore R, Walker JF. Early warning systems and evacuation: rare and extreme versus frequent and small-scale tropical cyclones in the Philippines and Dominica. DISASTERS 2021; 45:691-716. [PMID: 32129911 DOI: 10.1111/disa.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Survey questionnaires were administered among populations affected by Super Typhoon Yolanda in the Philippines in 2013 and Hurricane Maria in Dominica in 2017 to test the efficacy of early warning systems in prompting residents to take appropriate action ahead of severe hazards. Both events were rare and extreme but occurred in locations that regularly experience less severe tropical cyclones. The research assessed if, how, and when residents received warnings, what instructions were given, and where and when people decided to seek safety. In both of the cases under review, residents were aware of the approaching storms, but critical information on their severity and potential impacts was either not received in time or not understood fully, resulting in low levels of evacuation and safety-seeking behaviour. This paper suggests that planning and public communication need to focus on the uncertainty surrounding the severity and multifaceted nature of tropical cyclones and accompanying hazards and their consequences.
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Affiliation(s)
- Rebekah Yore
- PhD Candidate, Institute for Risk and Disaster Reduction, University College London, United Kingdom
| | - Joanna Faure Walker
- Senior Lecturer, Institute for Risk and Disaster Reduction, University College London, United Kingdom
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Pediatric Injuries Treated at a Level 1 Trauma Center After an F5 Tornado. Pediatr Emerg Care 2018; 34:783-786. [PMID: 30395071 DOI: 10.1097/pec.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND On May 22, 2011, an F5 tornado ripped through the city of Joplin, Mo, resulting in over 150 fatalities and over 750 injuries. Pediatric trauma centers in the region needed to be prepared to receive patients. Little data exist on the types of patients who are received at pediatric trauma centers after disasters such as tornados. OBJECTIVE The purpose of this study is to describe the patients received at the nearest level 1 pediatric trauma center after the tornado. METHODS Cases were identified through the trauma registry. Data regarding patient demographics, past medical history, characteristics of injury, treatment received, and outcomes were obtained retrospectively from medical records. RESULTS A total of 10 patients were received at the pediatric trauma center. Traumatic brain injury was the most common diagnosis followed by orthopedic and maxillofacial injuries. Seven patients required surgical procedures in the operating room, but only 1 patient required surgery within the first 24 hours of arrival. Eight patients were intubated and were in the pediatric intensive care unit. The average length of stay in the hospital was 19.4 days with a range of 14 hours to 94 days. CONCLUSIONS Immediately after a significant tornado in the referral region, pediatric trauma centers need to prepare to receive patients. Head injuries will likely be common, and pediatric trauma centers will likely receive multiple intubated patients. Knowledge of injuries received and resources needed can better prepare these trauma centers for future devastating tornadoes.
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Chan EYY, Sondorp E. Medical Interventions following Natural Disasters: Missing out on Chronic Medical Needs. Asia Pac J Public Health 2016; 19 Spec No:45-51. [DOI: 10.1177/101053950701901s08] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- EYY Chan
- London School of Hygiene and Tropical Medicine, London, UK
| | - E Sondorp
- London School of Hygiene and Tropical Medicine, London, UK
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Goldman A, Eggen B, Golding B, Murray V. The health impacts of windstorms: a systematic literature review. Public Health 2014; 128:3-28. [DOI: 10.1016/j.puhe.2013.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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Niederkrotenthaler T, Parker EM, Ovalle F, Noe RE, Bell J, Xu L, Morrison MA, Mertzlufft CE, Sugerman DE. Injuries and post-traumatic stress following historic tornados: Alabama, April 2011. PLoS One 2013; 8:e83038. [PMID: 24367581 PMCID: PMC3867464 DOI: 10.1371/journal.pone.0083038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/30/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. METHODS We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls. RESULTS Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤ 15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10-23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04-0.40), bathrooms (OR, 0.22; 95% CI: 0.06-0.78), hallways (OR, 0.31; 95% CI: 0.11-0.90) and closets (OR, 0.25; 95% CI: 0.07-0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09-0.49), television (aOR, 0.45; 95% CI: 0.24-0.83), and sirens (aOR, 0.50; 95% CI: 0.30-0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events. CONCLUSIONS Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention (CDC), Scientific Education and Professional Development Program Office, Division of Applied Sciences, Epidemic Intelligence Service, Atlanta, Georgia, United States of America
- Current affiliation: Medical University of Vienna, Center for Public Health, Department of General Practice and Family Medicine, Vienna, Austria
| | - Erin M. Parker
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention (CDC), Scientific Education and Professional Development Program Office, Division of Applied Sciences, Epidemic Intelligence Service, Atlanta, Georgia, United States of America
| | - Fernando Ovalle
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America
| | - Rebecca E. Noe
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Division Of Environmental Hazards & Health Effects, Atlanta, Georgia, United States of America
| | - Jeneita Bell
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America
| | - Likang Xu
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Division of Analysis, Research, and Practice Integration, Atlanta, Georgia, United States of America
| | - Melissa A. Morrison
- Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response, Atlanta, Georgia, United States of America
- Alabama Department of Public Health (ADPH), Montgomery, Alabama, United States of America
| | - Caitlin E. Mertzlufft
- Agency for Toxic Substances and Disease Registry (ATSDR), Division Of Toxicology And Human Health Sciences, Geospatial Research, Analysis And Services Program, Atlanta, Georgia, United States of America
| | - David E. Sugerman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Unintentional Injury Prevention, Atlanta, Georgia, United States of America
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Curtis A, Fagan WF. Capturing Damage Assessment with a Spatial Video: An Example of a Building and Street-Scale Analysis of Tornado-Related Mortality in Joplin, Missouri, 2011. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/00045608.2013.784098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marchigiani R, Gordy S, Cipolla J, Adams RC, Evans DC, Stehly C, Galwankar S, Russell S, Marco AP, Kman N, Bhoi S, Stawicki SPA, Papadimos TJ. Wind disasters: A comprehensive review of current management strategies. Int J Crit Illn Inj Sci 2013; 3:130-42. [PMID: 23961458 PMCID: PMC3743338 DOI: 10.4103/2229-5151.114273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed.
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Affiliation(s)
- Raffaele Marchigiani
- Department of Surgery, Temple St Luke's Medical School, Bethlehem, Pennsylvania, United States of America
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Chiu CH, Schnall AH, Mertzlufft CE, Noe RS, Wolkin AF, Spears J, Casey-Lockyer M, Vagi SJ. Mortality from a tornado outbreak, Alabama, April 27, 2011. Am J Public Health 2013; 103:e52-8. [PMID: 23763401 DOI: 10.2105/ajph.2013.301291] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We describe the demographics of the decedents from the tornado outbreak in Alabama on April 27, 2011; examine the circumstances of death surrounding these fatalities; and identify measures to prevent future tornado-related fatalities. METHODS We collected information about the decedents from death certificates, disaster-related mortality surveillance, and interview data collected by American Red Cross volunteers from the decedent's families. We describe demographic characteristics, circumstances and causes of death, and sheltering behaviors before death. RESULTS Of the 247 fatalities, females and older adults were at highest risk for tornado-related deaths. Most deaths were directly related to the tornadoes, on scene, and trauma-related. The majority of the deceased were indoors in single-family homes. Word of mouth was the most common warning mechanism. CONCLUSIONS This tornado event was the third deadliest in recent US history. Our findings support the need for local community shelters, enhanced messaging to inform the public of shelter locations, and encouragement of word-of-mouth warnings and personal and family preparedness planning, with a special focus on assisting vulnerable individuals in taking shelter.
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Affiliation(s)
- Cindy H Chiu
- Health Studies Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop F-60, Atlanta, GA 30341, USA.
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Miller JH, Zywicke HA, Fleming JB, Griessenauer CJ, Whisenhunt TR, Okor MO, Harrigan MR, Pritchard PR, Hadley MN. Neurosurgical injuries resulting from the 2011 tornados in Alabama: the experience at the University of Alabama at Birmingham Medical Center. J Neurosurg 2013; 118:1356-62. [DOI: 10.3171/2013.3.jns121656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The April 27, 2011, tornados that affected the southeastern US resulted in 248 deaths in the state of Alabama. The University of Alabama at Birmingham (UAB) Medical Center, the largest Level I trauma center in the state, triaged and treated a large number of individuals who suffered traumatic injuries during these events, including those requiring neurosurgical assessment and treatment.
Methods
A retrospective review of all adult patients triaged at UAB Medical Center during the April 27, 2011, tornados was conducted. Those patients who were diagnosed with and treated for neurosurgical injuries were included in this cohort.
Results
The Division of Neurosurgery at UAB Medical Center received 37 consultations in the 36 hours following the tornado disaster. An additional patient presented 6 days later, having suffered a lumbar spine fracture that ultimately required operative intervention. Twenty-seven patients (73%) suffered injuries as a direct result of the tornados. Twenty-three (85%) of these 27 patients experienced spine and spinal cord injuries. Four patients (15%) suffered intracranial injuries and 2 patients (7%) suffered combined intracranial and spinal injuries. The spinal fractures that were evaluated and treated were predominantly thoracic (43.5%) and lumbar (43.5%). The neurosurgery service performed 14 spinal fusions, 1 ventriculostomy, 2 halo placements, 1 diagnostic angiogram, 1 endovascular embolectomy, and 1 wound debridement and lavage. Twenty-two patients (81.5%) were neurologically intact at discharge and all but 4 had 1 year of follow-up. Three patients had persistent deficits from spinal cord injuries and there was 1 death in a patient with multisystem injuries in whom no procedures were performed. Two patients experienced postoperative complications in the form of 1 wound infection and 1 stroke.
Conclusions
The April 27, 2011, tornados in Alabama produced significant neurosurgical injuries that primarily involved the spine. There were a disproportionate number of patients with thoracolumbar fractures, a finding possibly due to the county medical examiner's postmortem findings that demonstrated a high prevalence of fatal cervical spine and traumatic brain injuries. The UAB experience can be used to aid other institutions in preparing for the appropriate allotment of resources in the event of a similar natural disaster.
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Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado. Disaster Med Public Health Prep 2013; 1:90-5. [DOI: 10.1097/dmp.0b013e31815901dc] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACTBackground: On May 4, 2007 an EF5 tornado hit the rural community of Greensburg, KS, destroying 95% of the town and resulting in 12 fatalities.Methods: Data was requested from the emergency medical services units that initially responded and the regional hospitals that received people injured in the tornado within 24 hours following the tornado. Requested data included patient age and sex, and injury severity score or ICD-9 codes. Critical mortality, or the number of deaths of critically injured patients, was also calculated.Results: The extensive damage caused by the tornado effectively destroyed the infrastructure of the community and created enormous challenges for emergency medical services responders, who were unable to record any triage data. Area hospitals treated 90 patients, who had an average injury severity score of 6.4. Age was found to be related to injury severity, but no relationship between sex and injury severity was found. Critical mortality was found to be 18% for this event.Conclusions: Injury severity score has seldom been used to analyze natural disasters, especially tornadoes, although such analysis is helpful for understanding the magnitude of the disaster, comparing to other disasters, and preparing for future incidents. Advanced warning and personal preparedness are important factors in reducing tornado-related injuries and deaths. (Disaster Med Public Health Preparedness. 2007;1:90–95)
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Hartmann EH, Creel N, Lepard J, Maxwell RA. Mass Casualty following Unprecedented Tornadic Events in the Southeast: Natural Disaster Outcomes at a Level I Trauma Center. Am Surg 2012. [DOI: 10.1177/000313481207800716] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.
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Affiliation(s)
- Elizabeth H. Hartmann
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Nathan Creel
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Jacob Lepard
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Robert A. Maxwell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
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Comstock RD, Mallonee S. Get Off the Bus: Sound Strategy for Injury Prevention During a Tornado? Prehosp Disaster Med 2012; 20:189-92. [PMID: 16018508 DOI: 10.1017/s1049023x00002430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the “F Scale”) struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris.Methods:A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck.Results:Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate= 79.2%).While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were lesssevere (median injury severity score (ISS) 1 versus 4).Conclusion:For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.
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Affiliation(s)
- R Dawn Comstock
- The Ohio State University, College of Medicine and Public Health, Department of Pediatrics, Columbus, Ohio 43205, USA.
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Chern JJ, Miller JH, Tubbs RS, Whisenhunt TR, Johnston JM, Wellons JC, Rozzelle CJ, Blount JP, Oakes WJ. Massive pediatric neurosurgical injuries and lessons learned following a tornado disaster in Alabama. J Neurosurg Pediatr 2011; 8:588-92. [PMID: 22132917 DOI: 10.3171/2011.9.peds11207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A large volume of patients presented to a Level I pediatric trauma center during and after a recent tornado disaster. Injuries of the central and peripheral nervous systems and the medical responses of a pediatric neurosurgical team are reviewed. METHODS The clinical courses of patients who suffered cranial, spinal, and peripheral nerve injuries due to the tornado storm are reported. The clinical actions taken by the neurosurgical team during and after the event are reviewed and the lessons learned are discussed. RESULTS The tornado storm system moved through the Tuscaloosa and Birmingham metropolitan areas on the early evening hours of April 27, 2011. Twenty-four patients received care from the neurosurgical team. A total of 11 cranial (including placement of an external ventricular drain), 2 spine, and 2 peripheral procedures were performed for the victims. Nine procedures were performed within the first 12 hours of the event, and an additional 6 surgeries were performed in the following 24 hours. Injuries of the peripheral nervous system often presented in a delayed fashion. Several key components were identified that enabled adequate neurosurgical care for a large influx of acute patients. CONCLUSIONS Massive casualties due to tornados are rare. A well-organized physician team working with the hospital administration may decrease the mortality and morbidity of such events.
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Affiliation(s)
- Joshua J Chern
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
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Sugimoto JD, Labrique AB, Ahmad S, Rashid M, Shamim AA, Ullah B, Klemm RDW, Christian P, West KP. Epidemiology of tornado destruction in rural northern Bangladesh: risk factors for death and injury. DISASTERS 2011; 35:329-345. [PMID: 21073669 DOI: 10.1111/j.1467-7717.2010.01214.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The epidemiology of tornado-related disasters in the developing world is poorly understood. An August 2005 post-tornado cohort study in rural Bangladesh identified elevated levels of death and injury among the elderly (≥ 60 years of age) (adjusted odds ratio (AOR) = 8.9 (95 per cent confidence interval (CI): 3.9-20.2) and AOR = 1.6 (95 per cent CI: 1.4-1.8), respectively), as compared to 15-24 year-olds, and among those outdoors versus indoors during the tornado (AOR = 10.4 (95 per cent CI: 5.5-19.9) and AOR = 6.6 (95 per cent CI: 5.8-7.5), respectively). Females were 1.24 times (95 per cent CI: 1.15-1.33) more likely to be injured than males. Elevated risk of injury was significantly associated with structural damage to the house and tin construction materials. Seeking treatment was protective against death among the injured, odds ratio = 0.08 (95 per cent CI: 0.03-0.21). Further research is needed to develop injury prevention strategies and to address disparities in risk between age groups and between men and women.
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Affiliation(s)
- Jonathan D Sugimoto
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, and Fred Hutchinson Cancer Research Center, United States
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Sutter D, Erickson S. The Time Cost of Tornado Warnings and the Savings with Storm-Based Warnings. ACTA ACUST UNITED AC 2010. [DOI: 10.1175/2009wcas1011.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
The authors examine the cost of time spent under tornado warnings issued annually by the National Weather Service (NWS). County-based tornado warnings imposed substantial costs on the nation: an average of 234 million person-hours spent under warnings annually between 1996 and 2004, with a value of $2.7 billion (U.S. dollars) per year. Counties are large relative to tornado damage areas; therefore, county-based warnings overwarned for tornadoes, warning many persons a safe distance from the storm and not in immediate danger. In October 2007 the NWS introduced storm-based warnings (SBW) for tornadoes, which are expected to reduce the area warned by 70%–75%. SBW consequently will reduce the time spent under warnings by over 160 million person-hours per year, with a value of $1.9 billion. The time spent under warnings does not measure the full cost to society because many people do not respond to the warnings. Adjusting for warning response, this study estimates that SBW might save 66 million person-hours actually spent sheltering a year with a value of $750 million. Sensitivity analysis indicates that the value of time spent sheltering saved by SBW exceeds $100 million per year with a probability of 0.95.
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Affiliation(s)
- Daniel Sutter
- The University of Texas–Pan American, Edinburg, Texas
| | - Somer Erickson
- Oklahoma Climatological Survey, University of Oklahoma, Norman, Oklahoma
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Comstock RD, Mallonee S. Comparing reactions to two severe tornadoes in one Oklahoma community. DISASTERS 2005; 29:277-87. [PMID: 16108992 DOI: 10.1111/j.0361-3666.2005.00291.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The authors compared the effect of the 3 May 1999 F5 and 8 May 2003 F3 tornadoes on the community of Moore, Oklahoma, by canvassing damaged areas after both tornadoes and surveying residents. Significantly more 1999 than 2003 residents reported property damage and injuries. Television and tornado sirens were the most common warnings each year, however, more 1999 residents received and responded to television warnings. Importantly, storm shelters were used more frequently in 2003. Fifty-one per cent of residents who experienced both tornadoes took the same amount of protective action in 2003 as they had in 1999; 22% took less; and 27% took more. Residents who took less action said that the reason for doing so was inadequate warning and shelter. First-hand experience of tornadoes prompts people to heed warnings when adequate notification is received and to take effective protective action when adequate shelter is available.
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Affiliation(s)
- R Dawn Comstock
- Injury Prevention Service, Oklahoma State Department of Health/Epidemiology Program Office, Division of Applied Public Health Training, Centers for Disease Control and Prevention, USA
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Daley WR, Brown S, Archer P, Kruger E, Jordan F, Batts D, Mallonee S. Risk of tornado-related death and injury in Oklahoma, May 3, 1999. Am J Epidemiol 2005; 161:1144-50. [PMID: 15937023 DOI: 10.1093/aje/kwi142] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
On May 3, 1999, powerful tornadoes, including a category F5 tornado, swept through Oklahoma. The authors examined all tornado-related deaths, hospital admissions, and emergency department visits to identify important risk factors. Data on deaths and injuries directly related to the tornadoes and information obtained from a survey of residents in the damage path of the F5 tornado were used in a case-control analysis. The direct force of the tornadoes caused 40 deaths, 133 hospital admissions, and 265 emergency department outpatient visits. The risk of death from the F5 tornado was greater for persons who were in mobile homes (odds ratio (OR) = 35.3, 95% confidence interval (CI): 7.8, 175.6) or outdoors (OR = 141.2, 95% CI: 15.9, 6,379.8) when the tornado struck than for those in permanently anchored houses. Risk of severe injury was also greater for persons in mobile homes (OR = 11.8, 95% CI: 3.4, 51.7) or outdoors (OR = 34.3, 95% CI: 4.4, 1,526.2). However, the risk of death (OR = 0.0, 95% CI: 0.0, 9.9), severe injury (OR = 0.0, 95% CI: 0.0, 2.0), or minor injury (OR = 0.8, 95% CI: 0.1, 3.1) was not greater among persons in motor vehicles than among those in houses. The risk of death (OR = 0.6, 95% CI: 0.1, 1.7), severe injury (OR = 0.2, 95% CI: 0.1, 0.6), or minor injury (OR = 0.3, 95% CI: 0.2, 0.7) was lower among those fleeing their homes in motor vehicles than among those remaining. Recommendations involving the relative safety of motor vehicles during a tornado should be evaluated using experience from recent tornado events.
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Affiliation(s)
- W Randolph Daley
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Greenough G, McGeehin M, Bernard SM, Trtanj J, Riad J, Engelberg D. The potential impacts of climate variability and change on health impacts of extreme weather events in the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2001; 109 Suppl 2:191-8. [PMID: 11359686 PMCID: PMC1240666 DOI: 10.1289/ehp.109-1240666] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Extreme weather events such as precipitation extremes and severe storms cause hundreds of deaths and injuries annually in the United States. Climate change may alter the frequency, timing, intensity, and duration of these events. Increases in heavy precipitation have occurred over the past century. Future climate scenarios show likely increases in the frequency of extreme precipitation events, including precipitation during hurricanes, raising the risk of floods. Frequencies of tornadoes and hurricanes cannot reliably be projected. Injury and death are the direct health impacts most often associated with natural disasters. Secondary effects, mediated by changes in ecologic systems and public health infrastructure, also occur. The health impacts of extreme weather events hinge on the vulnerabilities and recovery capacities of the natural environment and the local population. Relevant variables include building codes, warning systems, disaster policies, evacuation plans, and relief efforts. There are many federal, state, and local government agencies and nongovernmental organizations involved in planning for and responding to natural disasters in the United States. Future research on health impacts of extreme weather events should focus on improving climate models to project any trends in regional extreme events and as a result improve public health preparedness and mitigation. Epidemiologic studies of health effects beyond the direct impacts of disaster will provide a more accurate measure of the full health impacts and will assist in planning and resource allocation.
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Affiliation(s)
- G Greenough
- Department of Environmental Health Sciences, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA
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May AK, McGwin G, Lancaster LJ, Hardin W, Taylor AJ, Holden S, Davis GG, Rue LW. The April 8, 1998 tornado: assessment of the trauma system response and the resulting injuries. THE JOURNAL OF TRAUMA 2000; 48:666-72. [PMID: 10780600 DOI: 10.1097/00005373-200004000-00014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND On April 8, 1998, an F5 tornado touched down in two counties of Alabama producing a wide path of destruction. The presence of a regional trauma system in this area presents an opportunity to evaluate the effectiveness of the system in responding to the victims of this natural disaster. METHODS Emergency room logs and the regional trauma system database were searched for all patients treated for injuries sustained from the tornado, and medical records were reviewed for demographic information, mode of transportation to hospital, injuries, treatment, and outcome. Fatalities were identified by means of the coroner's office. RESULTS A total of 224 patients were evaluated at nine area hospitals, of whom 63 (28%) required admission. There were 32 deaths: 30 persons were dead at the scene, and 2 patients subsequently died at Level I trauma centers. Among patients with nonfatal injuries, 39% were managed at Level I facilities, 46% at Level III facilities, and 15% at nontrauma facilities. Forty patients (55%) seen at Level I facilities required admission compared with 15 patients (17%) at Level III facilities and 8 patients (29%) at nontrauma facilities; Level I facilities also had the highest Injury Severity Score. Of patients requiring admission, 83% were transported by emergency medical services; these patients also had the highest Injury Severity Score. CONCLUSION The regional trauma system facilitated appropriate and efficient triage to system hospitals, routing the most severely injured patients to the Level I centers without overwhelming them with the more numerous, less severely injured patients.
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Affiliation(s)
- A K May
- Center for Injury Sciences at the University of Alabama at Birmingham, 35294-0009, USA
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Millie M, Senkowski C, Stuart L, Davis F, Ochsner G, Boyd C. Tornado Disaster in Rural Georgia: Triage Response, Injury Patterns, Lessons Learned. Am Surg 2000. [DOI: 10.1177/000313480006600301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Our objective was to characterize the medical response and injury patterns from a recent tornado disaster in rural southeastern Georgia. We conducted a retrospective review of 11 patients treated at a Level I trauma center after sustaining injuries due to an April 9, 1998 F3 tornado. Data were obtained from trauma registry and medical records. Of 11 victims, 8 (73%) were male. Ages ranged from 5 to 54 years. Two patients were triaged directly by military heliopter, six arrived as secondary triage from local rural hospitals (2 by air, 4 by ground), and three arrived by delayed secondary transfer. Six patients were thrown by the tornado, and five were struck by flying debris. All victims were either in exposed areas or mobile homes. Injuries by anatomic region included the chest (45%), abdomen (27%), extremity (91%), and head (45%). Nine (82%) of the patients required surgical intervention. These included three laparotomies, one thoracotomy, six orthopedic procedures, and one neurosurgical procedure. The average Injury Severity Score (ISS) was 23. Among patients who were thrown mean ISS was 31; among those struck by debris, mean ISS was 12. Hemodynamically significant pelvic fractures occurred in three patients (27%). The major complication, sepsis due to Serratia marcescens was seen in three patients, all of whom had been thrown and had clinically significant wound contamination. Both patients who died had Serratia sepsis and multiorgan system failure. The injuries and inclement weather characteristic of tornado disasters stress regional trauma triage responses, cause significant injury, and disrupt communities. Injury patterns involve multiple systems and require coordinated efforts among caretakers. Infectious complications are common and frequently involve Gram-negative bacilli and are associated with soil-contaminated wounds. Trauma severity increases if the victim is thrown rather than struck by flying debris.
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Affiliation(s)
| | | | | | | | | | - Carl Boyd
- Memorial Medical Center, Savannah, Georgia
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25
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Abstract
North America suffers some of the most severe tornado disasters of any location on the planet. Significant injury and economic impact may result from these storms, particularly in rural areas. Tornadic storms present unique problems for prehospital and Emergency Department personnel. Soft tissue injuries seen after tornadoes are contaminated with polymicrobial flora and may require delayed primary closure. Fractures are a frequent cause of hospital admission and head injury is a frequent cause of death. Advanced warning and proper sheltering actions by a population are the most significant factors in reducing morbidity and mortality. This article reviews the pertinent literature on the medical impact of tornadoes and details the mechanisms of injury, nature of injuries, pre-hospital and ED planning points associated with tornadic storms.
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Affiliation(s)
- J J Bohonos
- Department of Emergency Services, Veterans Administration Hospital, University of Oklahoma, Oklahoma City, USA
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Abstract
This article discusses the relationship between disasters and infections. Infections that are reviewed include those resulting from (1) a breakdown of the usual mechanisms of infection control, (2) the introduction or emergence of pathogens, and (3) the movement of populations into new areas. Components of infectious-disease surveillance and disaster teams are detailed.
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Affiliation(s)
- M J Howard
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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28
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Schmidlin TW, King PS. Risk factors for death in the 27 March 1994 Georgia and Alabama tornadoes. DISASTERS 1995; 19:170-177. [PMID: 7600059 DOI: 10.1111/j.1467-7717.1995.tb00367.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Field surveys were made one week after tornadoes killed 40 persons and injured over 300 in rural regions of Alabama and Georgia, USA, on 27 March 1994. Surveys were completed for samples of 20 persons who were killed and 31 persons who were in the paths of the tornadoes but survived to determine whether there were differences in personal characteristics, behavior or location between the two groups. Persons who died were significantly older than persons who survived, more likely to be in mobile homes or in rooms above ground with windows, less likely to be watching television before the tornado, and were aware of the approaching tornado for less time than survivors. There was no difference in gender, race, marital status, education, disability or previous experience with tornadoes between those who died and survivors.
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Affiliation(s)
- T W Schmidlin
- Department of Geography, Kent State University, OH 44242, USA
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Lillibridge SR, Noji EK, Burkle FM. Disaster assessment: the emergency health evaluation of a population affected by a disaster. Ann Emerg Med 1993; 22:1715-20. [PMID: 8214862 DOI: 10.1016/s0196-0644(05)81311-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In the past decade, interest in the operational and epidemiologic aspects of disaster medicine has grown dramatically. State, local, and federal organizations have created vast emergency response networks capable of responding to disasters, while hospitals have developed extensive disaster plans to address mass casualty situations. Increasingly, the US armed forces have used both their ability to mobilize quickly and their medical expertise to provide humanitarian assistance rapidly during natural and man-made disasters. However, the critical component of any disaster response is the early conduct of a proper assessment to identify urgent needs and to determine relief priorities for an affected population. Unfortunately, because this component of disaster management has not kept pace with other developments in emergency response and technology, relief efforts often are inappropriate, delayed, or ineffective, thus contributing to increased morbidity and mortality. Therefore, improvements in disaster assessment remain the most pressing need in the field of disaster medicine.
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Affiliation(s)
- S R Lillibridge
- Disaster Assessment & Epidemiology Section, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tornado fatalities in Ohio, 1950–1989. ACTA ACUST UNITED AC 1993. [DOI: 10.1029/gm079p0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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